TEL-JOS-79

Code
TEL-JOS-79
Mercy ID
V-01158-02
Encounter Date
03/12/2003
Last
Tellez
First
Jose guadalupe
DOB
12/12/1979
County
Dekalb
Street
1728 Beardown Trl
City
Jonesboro
State
GA
Zip
30328-
Home
(678) 474-1229
Family Status
Adult coupie-no children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Tafoya
First
Celina
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
YES
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
No
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Jose Daniel Telles 02/05/2001 N/A GA/USA

Former Spouse 1 Information

Last
Gomez
First
Griselda
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
K. Aleman
Referred By
x3737